Dr. Carrie Cunningham and a colleague take a moment after a successful day in the OR.
Surgeons Reveal Stories of Struggle and Strength
Carrie Cunningham, MD, MPH, F抖阴传媒, past-president of the Association for Academic Surgery (AAS), shared her experiences with depression and substance use disorder and described a pivotal moment along her journey to mental wellness that occurred as she delivered her AAS presidential address in February 2023.
鈥淏eyond bringing my two children into the world, giving this address was the most important thing that I had ever done,鈥� she said. 鈥淔rom that day until now, I continue to receive emails, letters, and calls from those in crisis. I began my speech like this: 鈥榊es, I was a top junior tennis player at the age of 16, and I competed at Wimbledon five times. I am an associate professor of surgery at Harvard Medical School, and I am the president of the Association for Academic Surgery鈥攁nd I am also human. I am a person with lifelong depression, PTSD, and now a substance use disorder. None of my professional successes have protected me against this.鈥欌��
The title of her 50-minute speech, 鈥淩emoving the Mask,鈥� has generated more than 70,000 views to date on YouTube.
Dr. Sangki Oak intubates a foreign fighter that was injured while ambushing a nearby unit in Bala Murghab, Afghanistan.
鈥淢y intention in continuing to tell my story is to provide a voice for those of you who suffer silently,鈥� explained Dr. Cunningham. 鈥淚t has been shown time and again that experiencing a major medical error is something that we take home, we take it personally, and we rarely grieve. But there are things that are under our control. Live with intent, with overarching principles and boundaries, and find people who inspire you and support you. Practice mindful self-leadership. As leaders and allies, I urge you to become as knowledgeable about mental health disease as you are about every other disease. Psychological first aid should be a requirement.鈥�
The key to mitigating the hidden emotional burdens carried by many surgeons is to first acknowledge their unprecedented role within the domain of healthcare. Surgeons perform in high-stakes environments in which they routinely manage life-and-death decisions and shoulder substantial accountability for patient outcomes.
鈥淭he unique and silent struggles of the surgeon include excessive workload, responsibility for patient outcomes, and a lack of a work-life balance鈥攁ll of these can take a toll on a surgeon鈥檚 mental health,鈥� said Kamal M. F. Itani, MD, F抖阴传媒, session comoderator. 鈥淚t is imperative that we acknowledge these challenges and have the resources to address these mental issue needs in order to protect our well-being.鈥�
Dr. Sangki Oak operates with another resident on a patient at BWH.
Sangki Oak, MD, MPH, provided the resident perspective on maintaining mental wellness. Dr. Oak鈥攁 former Special Amphibious Reconnaissance Corpsman with US Marine Special Operations鈥攕erved in multiple deployments in Afghanistan after 9/11.
鈥淢y name is Sangki Oak. I鈥檓 a fifth-year surgical resident at Brigham and Women鈥檚 Hospital (BWH) in Boston, a combat military veteran, and I have a mental illness,鈥� said Dr. Oak. 鈥淢y journey from the military to surgical residency has resulted in mental illnesses that have ended up severely affecting my life and my performance and have even led me to being held back in my program. I鈥檓 here because I want to help others avoid the same challenges I went through and that some have not survived.鈥�
Although the data can vary depending on specialty and other factors, one study found that 75% of general surgery residents demonstrated signs of burnout, and 40% exhibited symptoms of depression.
鈥淲hen I got back from Afghanistan, I felt that I made it through my service relatively unscathed. I didn鈥檛 have nightmares. I didn鈥檛 jump at loud noises. I wasn鈥檛 abusing drugs or alcohol. And I had a plan,鈥� said Dr. Oak. 鈥淏ut during the beginning of medical school, I started questioning my life, and I found that I missed the military, so I began developing suicidal ideation. There were several times when I sat at the edge of my bed with my pistol in my hand contemplating putting a bullet in my head.鈥�
The ABCs for Supporting Surgeons Experiencing Emotional Distress
Dr. Oak started seeing a psychiatrist through Veterans Affairs, and he eventually matched in surgery at BWH in 2020.
鈥淚鈥檝e been asked by my fellow residents whether I found residency or the military harder. I tell them that, for me, general surgery residency has been harder than war. I felt a greater sense of camaraderie in the military. We relied on and trusted the person to your left and to your right and would do anything to protect them. And while I feel that patient care is a team effort, I鈥檝e observed a culture in surgery that often dictates that 鈥業鈥� am the only one who can save the patient, so we are bred to not trust anyone else.鈥�
Dr. Oak noted that while the miliary employs a 鈥渃rawl, walk, run鈥� approach to learn complex actions, like learning how to shoot a firearm, surgical residents are 鈥渢hrown in the fire early in their training.鈥�
He also described how the concept of grit during residency training is a double-edged sword because, while it allows people to push farther, it also propels them to push past their limits. Grit, in this context, is often described as a deep commitment to achieving long-term goals, with an enduring ability to recover from failure, setbacks, and adversity.
鈥淚 believe that the characteristics of smart, motivated, and driven people with high standards for themselves鈥攖raits that epitomize almost all surgical residents鈥攃an lead to constant denial of our mental state,鈥� explained Dr. Oak. 鈥淲e tell ourselves that 鈥業鈥檓 okay. I鈥檓 fine鈥� and put on a strong face to the rest of the world. Of course, since everyone has this strong fa莽ade, people think that everyone else is doing fine so I should be fine too. We then fool ourselves and just keep our heads down and survive because it鈥檚 only a certain number of years of residency, and then it gets better. Though it鈥檚 questionable if it really does.鈥�
Dr. Oak鈥檚 dual background in military service and medical training has given him a unique vantage point to compare how each system addresses mental health.
鈥淪urgical training is tough as it is, and the culture can make it tougher than it needs to be. It even ended up breaking a decorated, war-hardened, special operations veteran like myself,鈥� said Dr. Oak. 鈥淭o those who know they鈥檙e hurting, I implore you to find help before it gets worse. For those of you who think you鈥檙e fine, I ask you to take a good, hard look at yourself and how you act in the OR and with others. You may be struggling more than you would care to admit. The first step to healing is acknowledging what is going on inside yourself. While my journey has been tough, I truly believe that in the end, I鈥檒l be a better provider, surgeon, and person because of all this.鈥�
Don鈥檛 Medicalize Suffering, Humanize It
Surgeons can start their journey toward improved well-being by understanding the profound difference between pain鈥攁 physical sensation颅鈥攁nd suffering鈥攁 broader emotional and psychological experience.
Dr. Mary Brandt suggests mental wellness begins with discovering root causes for suffering and pain.
鈥淧ain is a normal part of the practice of surgery,鈥� said Mary L. Brandt, MD, MDiv, F抖阴传媒. 鈥淲e experience physical pain from ergonomic injury or medical-related causes; we experience emotional pain from the suffering our patients endure; and we experience spiritual pain from moral distress or the inability to find meaning.鈥�
Dr. Brandt suggested the surgical community adopt a person-centered approach for mitigating mental distress experienced by a colleague, which takes into account potential root causes for suffering and pain.
鈥淲hat we tend to do as doctors, and it鈥檚 completely understandable, is that we medicalize suffering, particularly in our colleagues. We want a diagnosis, we want a prognosis, we want to treat it, we want to know what the outcome is. We put it into the same box we put breast cancer,鈥� explained Dr. Brandt. 鈥淲e medicalize suicidal ideation and say, 鈥業f only they had gotten treatment and if only they had been on the right medication, this would have never happened.鈥欌��
To support surgeons in emotional distress, Dr. Brandt suggested following the ABC approach: Act if there is there is imminent danger to yourself or others; Be present (listen attentively and do not try to fix the situation); and let Compassion arise.
鈥淗ow do you let compassion arise? Bear witness and don鈥檛 look away. Choose to feel empathy鈥攁nd then tolerate the discomfort that arises in response to your empathy. Any pain鈥攑hysical, emotional, spiritual鈥攖hat causes intense suffering can lead to the inability to see beyond that suffering,鈥� Dr. Brandt said, while also urging surgeons to help their colleagues determine the source of their pain.
鈥淭here comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they鈥檙e falling in,鈥� she said, quoting bishop and theologian Desmond Tutu.
Dr. Tasha Hughes underscores the importance of self-assessment tools to sustain emotional well-being.
Mental Health Maintenance Starts with Preventive Approach
Determining the root cause of emotional distress can help inform preventive mental healthcare.
鈥淪urgeons, at our core, are helpers and healers, and because of that, we often need to suppress or compartmentalize our emotions,鈥� said Tasha Hughes, MD, F抖阴传媒. 鈥淚t鈥檚 really important to stop and name your emotions: are you mad, are you sad, are you overwhelmed? Are you happy, are you proud? I think it鈥檚 good to name all of them, and there are lots of ways to do this.鈥�
Some emotional self-assessment tools could include patient-facing validated screens such as the Patient Health Questionnaire, also known as the PHQ-2, or burnout scales such as the Utrecht Burnout Scale. Other assessments are designed specifically for physicians, including resources developed by the American Medical Association, the 抖阴传媒, and other organizations.
Boundary setting is another essential component of preventive care. Executed correctly, establishing boundaries is a form of decision-making that should be revisited on a routine basis.
Dr. Stanley Ashley emphasized the importance of integrating surgeon mental health into the C-suite leadership strategy.
鈥淏oundary setting is not a one and done action,鈥� she said. 鈥淚t needs to be revisited monthly, quarterly, annually, because as we all know, in healthcare, the work is boundless. There is an unlimited number of patients, so therefore, you have to set boundaries because you are not limitless.鈥�
Dr. Hughes mentioned a colleague who has a quarterly alarm set on their calendar as a reminder to examine their current workload.
鈥淭he notification simply says 鈥榬eassess.鈥� No one else is on the invite. It is an opportunity for this individual to review what is on their plate right now. Is it the right mix? Is it a mix that is making me happy? Is there something that needs to go away professionally so that I can prioritize my identity outside of surgery?鈥�
Despite the strides taken to help surgeons overcome the stigma associated with mental distress, this cultural change continues to be a delicate undertaking for some.
鈥淭his is a professional shift, and it does feel uncomfortable for a lot of people,鈥� Dr. Hughes said. 鈥淓motional self-regulation, for me, has been a big part of my breaking through those dark first years as a faculty member. Doing it for yourself is enough. Your health is enough. And we鈥檙e also doing it so that we are here to take care of patients for the long haul.鈥�
Rethinking the C-Suite鈥檚 Role in Sustaining Surgeon Mental Health
During his tenure as chief medical officer at BWH (2011鈥�2019), Stanley W. Ashley, MD, F抖阴传媒, helped develop the BWH Faculty/Trainee Mental Health Program to address increased concerns regarding physician burnout and its impact on mental well-being. The program, launched in 2017, offers a free 30-minute virtual consultation without notes in the electronic health record. If continuing care is requested, up to six virtual sessions with a psychiatric care provider or a referral to an outside provider are available to the individual.
鈥淚 think the program at the Brigham is something almost every academic institution should have,鈥� said Dr. Ashley, who also was vice chair of surgery at BWH 2003鈥�2011.
鈥淚t behooves us to think about what we can do specifically to support surgeon mental well-being, and I don鈥檛 think that can come from the C-suite, surgical chair, division chief, or the program director,鈥� he said, calling for new roles at large academic institutions, such as a surgical mental health officer or a peer support officer, to adequately support the needs of faculty, trainees, and staff.
He noted that programs that specifically address surgeon depression and suicide ideation should offer resources that describe 鈥渢he continuum of distress, from depression to suicide, particularly by surgeons with experience.鈥�
Dr. Timothy Mahoney calls for surgeons to support each other鈥檚 wellness with the same vigor that members of police departments typically support one another.
Closing out the session, Timothy Mahoney, MD, F抖阴传媒, mayor of Fargo, North Dakota, and the session鈥檚 comoderator, presented a brief video highlighting the Fargo Police Department鈥檚 Wellness Initiative, which supports the physical, mental, and emotional health of its officers and civilian staff through peer counseling, training, and other services. Dr. Mahoney cited the initiative as an example of the kind of unwavering and profound emotional support surgeons should provide to their colleagues experiencing burnout and emotional distress.
The 抖阴传媒 provides resources on mental health, emotional well-being, suicide prevention and awareness, and more: facs.org/wellbeing/.
Tony Peregrin is the Managing Editor, Special Projects in the 抖阴传媒 Division of Integrated Communications in Chicago, IL.
Bibliography
Frangou C. US surgeons are killing themselves at an alarming rate. One decided to speak out. Daily Guardian. September 26, 2023. Available at: . Accessed October 22, 2025.
Williford ML, Scarlet S, Meyers MO, et al. Multiple-institution comparison of resident and faculty perceptions of burnout and depression during surgical training. JAMA Surg. 2018; 153(8):705-711.
